Provider Demographics
NPI:1437870862
Name:LIBERATI, CHRISTOPHER PATRICK (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:LIBERATI
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4305
Mailing Address - Country:US
Mailing Address - Phone:217-778-6898
Mailing Address - Fax:
Practice Address - Street 1:16 WINEBERRY LN
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4305
Practice Address - Country:US
Practice Address - Phone:217-778-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010896-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant